Accuracy isn’t priority as VA battles disability claims backlog

U.S. Navy cook Hosea Roundtree watched the 1983 shelling of Beirut from the deck of a ship, feelings of helplessness washing over him as people perished onshore. That memory haunted him, resurrected in flashbacks eight years later after a tour in the Gulf during Operation Desert Storm.

But when Roundtree’s claim for disability compensation crossed Jamie Fox’s desk at the Department of Veterans Affairs more than two decades later, it was slated for denial on the grounds that he had never seen combat. Fox, herself a Navy veteran, tried to straighten things out – and for that, she lost her job.

A lawsuit filed by the former VA disability claims representative provides a rare glimpse into what veterans’ advocates call systemic problems in how the agency handles compensation claims filed by Americans wounded physically or mentally in the line of duty.

A Center for Investigative Reporting review of the VA’s performance data reveals chronic errors – committed in up to 1 in 3 cases – and an emphasis on speed over accuracy that clogs the VA system with appeals, increasing delays for all veterans.

“When the VA makes a mistake processing a veteran’s claim, then our veterans face another unacceptably long wait,” said Paul Sullivan, a Gulf War veteran and former senior VA project manager who now works for the Washington, D.C.-area law firm Bergmann & Moore.

As of mid-October, appeals represented nearly a third of the more than 819,000 pending disability claims. Nationwide over the past year, the average time a veteran waits for a decision has increased by more than two months – to 260 days. Veterans who appeal wait an average of 3½ years, according to VA data obtained through the Freedom of Information Act.

In a deposition related to a federal discrimination complaint filed by Fox, the head of the Oakland VA regional office where Fox worked, Lynn Flint, said “it didn’t matter if the decision (to deny Roundtree’s claim) was right or wrong.” In proceedings related to Fox’s wrongful termination suit, Flint and Fox’s supervisor, Kim Yarbrough, argued that Fox exceeded her authority by advocating for additional review of Roundtree’s case, lowering her productivity to unacceptable levels.

If Roundtree disagreed with the denial, Yarbrough said, he could always appeal.

The VA declined to comment further on Fox’s dismissal, citing the ongoing litigation.

Across the country, the VA’s inability to stem a tide of errors has increasingly frustrated lawmakers from both political parties, who frequently hear from distraught constituents.

The Board of Veterans’ Appeals found errors by VA staff in 35,000 of the nearly 50,000 appeals decided in 2011, according to the board’s annual report. In 29 percent of cases, the board overturned the agency’s initial decision and ruled in favor of the veteran.

“There is no benefit in pushing a determination out that is wrong because, in the end, it will be appealed, and it’s going to make the record look even worse,” said U.S. Rep. Jackie Speier, a California Democrat working to reform the VA’s Oakland office.

The VA acknowledges it makes mistakes on 14 percent of disability claims – an error rate the agency considers unacceptable and has pledged to all but eliminate by 2015.

A CIR analysis of 18 audits published this year by the VA’s inspector general shows the problem could be much worse, especially in high-profile cases. The analysis found a 38 percent average error rate for claims involving disabilities like traumatic brain injury and illnesses linked to the Vietnam-era defoliant Agent Orange.

VA officials say the inspector general’s reports “do not present a true picture of the overall quality of the work performed” by VA employees because they sample “specific types of claims.”

VA employee Fox was forced out in 2008, after she told her supervisor that the agency was poised to wrongfully deny benefits to Roundtree, a 17-year Navy veteran who claimed to have developed post-traumatic stress disorder and depression. The VA said it could find no evidence that Roundtree had experienced combat in Beirut, but through an Internet search Fox confirmed his ship, the USS Arthur W. Radford, had engaged in battle.

“It was a gut-wrenching story when I went through his file,” Fox said.

Roundtree, she said, had “been a star in the Navy” but ended up homeless on the streets of Long Beach after a mental breakdown.

Fox wrote a four-page memo to her supervisor arguing that the VA should “wait to send out the award of denial” to allow further research. Five months later, the VA gave her a choice: Resign or be fired. She opted to resign.

In Fox’s termination letter, the head of the Oakland office, Flint, criticized Fox for “failure to follow instructions” and “misuse of time” for not immediately sending Roundtree a letter denying his benefits.

Two years earlier, when Roundtree filed his claim, he was living in a transitional housing program for homeless veterans on the VA’s hospital complex in West Los Angeles. The former petty officer 1st class had been in and out of jail and lived on the streets for more than a decade following his tour in the Persian Gulf.

Roundtree, now 54, blames his service in the Gulf for triggering intense flashbacks of the shelling of Beirut. He received an honorable discharge from the Navy in 1989, but received a bad-conduct discharge for drug use after serving in the Gulf. Roundtree says he began using crack cocaine after he left the military.

“I lost it. I had a major breakdown,” he said.

In 1993, he walked out on his wife and two daughters and buried himself in crack to blot out the intrusive thoughts of carnage along the Lebanese shore. “I couldn’t shut my mind down,” he said.

When he finally received a denial letter from the VA in 2008, he said its words came as a shock. It cited insufficient evidence “to confirm that you actually engaged in combat.”

Today, Roundtree calls Fox “an angel” for catching an apparent error that might have cost him thousands of dollars in compensation for his war wounds, and he expresses outrage that she was forced out for speaking up on his behalf.

Productivity is priority

Four years after Fox left her job, she and the VA continue to battle in court. Government lawyers argue that it does not matter whether VA employees wrongly deny claims. What is important, officials said, is to be highly productive – as measured by the number of cases employees clear from the inventory.

Under questioning from an administrative law judge in 2010, Fox’s supervisor, Yarbrough, said Fox should have immediately sent Roundtree a letter denying his claim despite her concerns because “it was a very old case.”

Gordon Erspamer, a senior counsel based in San Francisco at the law firm Morrison & Foerster who has practiced veterans law for more than three decades, said the agency likely violated the Veterans Claims Assistance Act of 2000 in Roundtree’s case.

“The courts have held that the VA has a duty to assist the veteran in developing the facts and evidence to support his or her claim,” Erspamer said.

Fox went on unemployment after she lost her job and moved in with her sister. Two years later, she found a new job – working at a VA health care center in Santa Rosa.

Six months ago, she found Roundtree on Facebook.

“I was so nervous calling,” she said.

What she hoped to hear was that his claim had been approved, she said, “or if it wasn’t approved that he would have appealed it.”

But Roundtree had never filed an appeal. The day he received his denial letter, he received a job offer. Roundtree now works as a cook at the VA Medical Center in Sacramento.

In June, Fox and Roundtree met for the first time. Because the time limit for Roundtree to appeal his denial had passed, Fox helped him file a new disability claim.

Five months later – and six years after he first sought compensation for the mental wounds he received in uniform – Roundtree is still waiting.

This story was edited by Amy Pyle and copy edited by Nikki Frick and Christine Lee.

This story was produced by the nonprofit Center for Investigative Reporting, the country’s largest investigative reporting team. For more, visit cironline.org. Contact the reporter at aglantz@cironline.org.